Aneurysm of the Aorta
The possibility for correcting abnormalities of the
major blood vessels is one of the major advances of the
post
World War II era. This is true not only because of
new techniques but because suitable prosthetic sterile
material is now available to substitute for diseased blood
vessels. Modern refinements in X ray have made it possible
to visualize diseased arteries for diagnosis and as an
aid in planning reconstructive operations. These techniques
have been so well developed that all major hospitals
should be familiar with them. Thirty years ago the diagnosis of an aneurysm of the aorta meant that the patient
would not be expected to survive more than twenty four
months. Today early surgery for this disease is done with
no greater risk than for other major
abdominal operations.
What is the aorta?
The aorta is the largest and longest blood vessel. It carries
blood from the heart to the rest of the body and has
branches that extend to each of the organs and body
parts.
What is an aneurysm?
An aneurysm is an abnormal localized bulge in the
wall of the artery. It is like a blister on the artery. The
wall of the artery is diseased, so it can no longer confine
the blood flow to one straight path.
What is the cause of it and why is it so serious?
Most . aneurysms are due to arteriosclerosis, but an
aneurysm can result from an injury or an infection in
the artery wall. It's serious if the blood in the aneurysm
clots and closes off the aorta or if the pressure in the
artery thins out its wall so much that the aneurysm is in
danger of rupturing the wall. In the former instance the
blood supply to the viscera and legs is diminished; in the
latter situation the individual can exsanguinate.
Do these occur only in the aorta?
All arteries can be so weakened that they become aneurysmal.
This disease is also frequent in the artery behind
the knee and in the thigh, in which case the blood supply
to the leg is jeopardized. Those at the base of the brain
can be the source for
brain hemorrhage.
Can this disease be prevented?
If the disease is due to arteriosclerosis, there is no way of preventing it. Einstein died of an abdominal aneurysm
at a time before the surgery for this problem was well
developed. However, when the aneurysm results from
syphilitic infection, the disease occurs in the part of the
aorta that is in the chest. It can be prevented by early
adequate treatment of the primary disease.
How do you make the diagnosis?
It is usually possible to feel the abnormally pulsating
artery in the abdomen near the area of the navel. The
X ray will verify its presence. Verification is needed because
sometimes, especially in a person with high blood
pressure, the strong pulse in the aorta may be caused by
something else.
What is the treatment?
The only treatment is surgical. No medical or other
method affects the diseased artery. The operation entails
removal of the diseased part of the artery that has the
aneurysm and then connection of the upper and lower
ends by means of a plastic tube graft. The tube is made
of the same dacron used for clothes, only the material
has a more closely knit weave. With the tube, the blood
will flow normally.
When is the operation absolutely necessary?
If the aneurysm is in danger of rupturing, surgery
should be done immeditely. There is no alternative. An
operation done before complications can be satisfactory
in eight out of ten people. If an emergency operation is
required because of rupture, only three to five people
of these same ten can be expected to do as well. The
doctor suspects that the wall of the artery is thinning out
and is in danger of bursting open if it produces backache
and if it is judged to be more than three and one half
inches in size. The patient in this stage of the disease
requires prompt attention.
When is the operation not necessary?
If the aneurysm is small and the patient has no symptoms
referable to it, then it is safe to observe him. Some
aneurysms never get to the dangerous stage.
What will happen if the operation is not done?
The realistic answer is that if the artery ruptures, the
operation at that time is five times as risky as before,
and if no operation is done, the patient will not survive.
One can't wait until the last minute to make a decision.
Aortic Aneurysm: What is it and how is it treated?
What does the difficulty in walking have to do with
this aneurysm?
They are related in that both are due to arteriosclerosis.
Sometimes the clot in an aneurysm breaks off and blocks
the circulation to the legs.
If I recover from the operation, how will I be then?
If the graft is inserted properly and the patient recovers,
he will be just as he was before but without the lifethreatening
danger of the diseased aorta.
Will you treat the diseased gallbladder, ulcer, appendix
or prostate at the same time?
No, it is not wise to expose the contents of the intestine
or of infected organs to the area of blood vessel sutures.
Infection of a graft is a most serious complication. Therefore,
surgery is limited to the correction of the diseased
aorta and collateral vascular problems.
